What are the responsibilities and job description for the Certified Social Worker & Utilization Review Specialist position at Tomah Health?
POSITION DETAILS
Full-time, benefitted; 72 hours per 2-week pay period, Day shift 7a-330p Monday-Friday; Includes holiday rotation.
JOB SUMMARY
The Certified Social Worker participates as member of the Interdisciplinary Team in the hospital setting. The Certified Social Worker completes assessments which are used to formulate a Comprehensive Interdisciplinary Plan of Care to address problems and resolve identified needs to support the goals of the patient and their family. The Certified Social Worker provides direct social work support and continues to help the patient and family identify and resolve any problems with psychosocial, economic, family dynamics, bereavement or coping issues.
SOCIAL WORKER MAJOR JOB FUNCTION
1. Encourages patient and family participation in developing a discharge plan and patient-centered goals in the transition from hospital to home or other community setting. The goal of the discharge planning is to reduce adverse events and prevent avoidable readmissions. Progress toward discharge goals are discussed with patients and their families.
2. Refers to appropriate resources as needed including in-home, out-of-home, outpatient or other community-based services. May also refer to county agencies.
3. Functions as a member of a multidisciplinary case management team and ensures a multidisciplinary approach to patient care by assessing and monitoring all patient's discharge planning needs. Any changes in assessed needs will require revising the discharge planning recommendations and reviewing the revised plan with each patient and family.
4. Addresses internal and external social, economic, emotional, medical, nursing and psychological needs, through referral, which will extend beyond the hospital.
5. Minimizes discharge delays and the unnecessary use of acute care resources.
6. Demonstrates excellent customer service by utilizing clear communication skills and continual evaluation of interactions with patient care staff, providers, patients and families.
7. Act as a resource person for other patient care staff and displays positive teamwork and leadership qualities so he/she may serve as an example to others.
8. Demonstrates proficiency in regards to the computer documentation of patient cares and any other related computerized patient information/documentation. Documents in medical record.
9. Serves as a resource person for staff, physicians and the community. Conducts informational sessions/education offerings as needed/directed.
10. Serves as a Patient Advocate by investigating, resolving, documenting and reporting organization-specific patient and visitor compliments and concerns and forwarding them to leadership and staff as appropriate.
11. Conducts debriefing sessions for staff as needed.
12. Works with patients, families, staff and the public to develop and review Advance Directives.
13. Continuously assesses and evaluates the patient and family's satisfaction and acceptance of services. Promptly attempts to correct any identified issues.
14. Acts as a resource and provides assistance to staff members in counseling regarding areas of personal or work stress or grief.
15. Recognizes personal need for support and demonstrates self-care behavior.
16. Performs all other duties as assigned.
UTILIZATION REVIEW MAJOR JOB FUNCTION
17. Under the direct supervision of the Acute Care Director, will review all patients admitted to the Acute Care Unit and the Women's Health Unit for proper admission class and accommodation code upon admission to Acute Care and Women's Health.
18. Utilizes current utilization guidelines and/or criteria and conducts utilization review for medical necessity (appropriateness) prospectively, concurrently and retrospectively. Determines the medical necessity of admission, continued stay, treatments, tests and procedures. Documents and addresses service delays. Provides recommendation for patient class to Hospitalist, Surgeon, etc.
19. Work with insurance companies regarding ongoing authorizations, swing bed stays, assist Prior Auth Department with insurance inquiries, denials, setting up provider peer to peer reviews, and processing Condition Code 44 documentation and variation from written orders.
20. This position will be responsible for signatures on admission Medicare and Insurance forms including but not limited to; Important Message from Medicare, MOON form, Observation Form, HINNs (Notice of Non coverage), ABNs (Advanced Beneficiary Notices) and VA forms. Legal Guardians, activated POAs, will be contacted via phone and verbal authorization obtained and forms processed. Will work with Patient Financial Services and HIS to ensure meeting financial regulatory requirements for a Critical Access Hospital.
21. This position will perform reviews on patient readmissions and record and collect necessary data and tracking.
22. Conducts follow-up calls to patients to address identified social concerns and provide appropriate support and resources.
STANDARDS OF BEHAVIOR
QUALIFICATIONS/SKILLS
Must understand and accept the possibility of exposure to inside environmental conditions, such as infectious/communicable diseases, noise, blood and bloodborne diseases, chemicals and/or chemical fumes, odors, gases, dusts, and physical injury/verbal abuse from an out-of-control patient. Frequent exposure to distressed patients, families or visitors. Must be able to function effectively under stressful situations. Position may involve driving to patient homes in various types of weather and road conditions.
Full-time, benefitted; 72 hours per 2-week pay period, Day shift 7a-330p Monday-Friday; Includes holiday rotation.
JOB SUMMARY
The Certified Social Worker participates as member of the Interdisciplinary Team in the hospital setting. The Certified Social Worker completes assessments which are used to formulate a Comprehensive Interdisciplinary Plan of Care to address problems and resolve identified needs to support the goals of the patient and their family. The Certified Social Worker provides direct social work support and continues to help the patient and family identify and resolve any problems with psychosocial, economic, family dynamics, bereavement or coping issues.
SOCIAL WORKER MAJOR JOB FUNCTION
1. Encourages patient and family participation in developing a discharge plan and patient-centered goals in the transition from hospital to home or other community setting. The goal of the discharge planning is to reduce adverse events and prevent avoidable readmissions. Progress toward discharge goals are discussed with patients and their families.
2. Refers to appropriate resources as needed including in-home, out-of-home, outpatient or other community-based services. May also refer to county agencies.
3. Functions as a member of a multidisciplinary case management team and ensures a multidisciplinary approach to patient care by assessing and monitoring all patient's discharge planning needs. Any changes in assessed needs will require revising the discharge planning recommendations and reviewing the revised plan with each patient and family.
4. Addresses internal and external social, economic, emotional, medical, nursing and psychological needs, through referral, which will extend beyond the hospital.
5. Minimizes discharge delays and the unnecessary use of acute care resources.
6. Demonstrates excellent customer service by utilizing clear communication skills and continual evaluation of interactions with patient care staff, providers, patients and families.
7. Act as a resource person for other patient care staff and displays positive teamwork and leadership qualities so he/she may serve as an example to others.
8. Demonstrates proficiency in regards to the computer documentation of patient cares and any other related computerized patient information/documentation. Documents in medical record.
9. Serves as a resource person for staff, physicians and the community. Conducts informational sessions/education offerings as needed/directed.
10. Serves as a Patient Advocate by investigating, resolving, documenting and reporting organization-specific patient and visitor compliments and concerns and forwarding them to leadership and staff as appropriate.
11. Conducts debriefing sessions for staff as needed.
12. Works with patients, families, staff and the public to develop and review Advance Directives.
13. Continuously assesses and evaluates the patient and family's satisfaction and acceptance of services. Promptly attempts to correct any identified issues.
14. Acts as a resource and provides assistance to staff members in counseling regarding areas of personal or work stress or grief.
15. Recognizes personal need for support and demonstrates self-care behavior.
16. Performs all other duties as assigned.
UTILIZATION REVIEW MAJOR JOB FUNCTION
17. Under the direct supervision of the Acute Care Director, will review all patients admitted to the Acute Care Unit and the Women's Health Unit for proper admission class and accommodation code upon admission to Acute Care and Women's Health.
18. Utilizes current utilization guidelines and/or criteria and conducts utilization review for medical necessity (appropriateness) prospectively, concurrently and retrospectively. Determines the medical necessity of admission, continued stay, treatments, tests and procedures. Documents and addresses service delays. Provides recommendation for patient class to Hospitalist, Surgeon, etc.
19. Work with insurance companies regarding ongoing authorizations, swing bed stays, assist Prior Auth Department with insurance inquiries, denials, setting up provider peer to peer reviews, and processing Condition Code 44 documentation and variation from written orders.
20. This position will be responsible for signatures on admission Medicare and Insurance forms including but not limited to; Important Message from Medicare, MOON form, Observation Form, HINNs (Notice of Non coverage), ABNs (Advanced Beneficiary Notices) and VA forms. Legal Guardians, activated POAs, will be contacted via phone and verbal authorization obtained and forms processed. Will work with Patient Financial Services and HIS to ensure meeting financial regulatory requirements for a Critical Access Hospital.
21. This position will perform reviews on patient readmissions and record and collect necessary data and tracking.
22. Conducts follow-up calls to patients to address identified social concerns and provide appropriate support and resources.
STANDARDS OF BEHAVIOR
- WORK ETHICS STANDARD: Affirm a commitment to making the Tomah Health work environment better through: patient advocacy, continuing education, and valuation of each individual person.
- COMMUNICATION STANDARD: Affirm a commitment to use open and honest communication with all Tomah Health customers (in-house & community-wide) through: basic customer courtesy (phone, written, face to face) and active listening.
- TEAMWORK STANDARD: Affirm a commitment to be a proud, dependable Tomah Health team member through: basic customer courtesy, patient advocacy, flexibility, and valuation of each individual person.
- QUALITY STANDARD: Affirm a commitment to provide respectful, compassionate, quality care with integrity to all Tomah Health customers (in-house & community-wide) through: job excellence, patient advocacy, and self-dignity.
- PROFESSIONALISM STANDARD: Affirm a commitment to professional conduct towards all Tomah Health customers (in-house & community-wide) through: collaboration, teamwork, appearance, environment, and valuation of each individual person.
- ATTITUDE STANDARD: Affirm a commitment to maintain a positive, professional perspective towards all Tomah Health customers (in-house & community-wide) through: honest feedback, confidentiality, basic customer courtesy, and valuation of each individual person.
- Minimum Bachelor's degree in the field of Social Work.
- Current licensure to permit to practice as a Certified Social Worker in the state of Wisconsin.
- Minimum of one year social work experience in a health care setting. At least three years of clinical experience preferred.
QUALIFICATIONS/SKILLS
- Excellent verbal and written communication skills.
- Excellent human relation skills as demonstrated by the ability to interface positively with all customers and employees.
- Must acquire the knowledge and maintain established competency levels to perform essential job function.
- Must have proficient computer skills with the ability to operate within a Windows environment.
- Must have the ability to work with frequent interruptions, under stress, with minimal supervision, and to exercise initiative and judgment in analyzing, organizing, planning, prioritizing, scheduling and coordinating work with others.
- Needs to possess as high level of intelligence, integrity, sense of responsibility and ability to comprehend and analyze details.
- Knowledge if theory, principles, techniques and practice of professional social work practice; of counseling and teaching techniques; and general knowledge of medical equipment as it relates to patient care.
- Ability to demonstrate clinical competence and maintain current knowledge in care and for the population served.
- Ability to provide counseling and address social or financial issues related to patient care needs including being knowledgeable of community resources and make referrals to appropriate sources.
- Must be able to communicate.
- The Certified Social Worker is frequently required to stand, walk and reach with hands and arms. The Certified Social Worker is occasionally required to sit, climb or balance, stoop, kneel or crouch.
- The Certified Social Worker must occasionally lift and/or move up to 25 pounds.
- Good hearing is necessary to receive detailed information through oral communication.
- Computer/keyboard skills are required. Must have the ability to operate in a Windows environment.
Must understand and accept the possibility of exposure to inside environmental conditions, such as infectious/communicable diseases, noise, blood and bloodborne diseases, chemicals and/or chemical fumes, odors, gases, dusts, and physical injury/verbal abuse from an out-of-control patient. Frequent exposure to distressed patients, families or visitors. Must be able to function effectively under stressful situations. Position may involve driving to patient homes in various types of weather and road conditions.